MEDICARE: 3S ORTHODONTICS, P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	DI19437	NJ

General Provider Information

NPI Number	:	1306278858
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	3S ORTHODONTICS, P.A.

Provider Business Mailing Address
First Line	:	669 BROAD AVE STE 102
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1631
Country	:	US
Telephone Number	:	201-840-1123
Fax Number	:	201-840-5699

Provider Business Practice Location Address
First Line	:	669 BROAD AVE STE 102
Second Line	:
City	:	RIDGEFIELD
State	:	NJ
Zip	:	07657-1631
Country	:	US
Telephone Number	:	201-840-1123
Fax Number	:	201-840-5699

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JINSANG KIM
Credential	:
Telephone Number	:	201-840-1123

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	08/07/2013

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